Provider Demographics
NPI:1760776256
Name:THOMAS-GREEN, JANICE JACQUELINE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:JACQUELINE
Last Name:THOMAS-GREEN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 HOOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3401
Mailing Address - Country:US
Mailing Address - Phone:845-440-6345
Mailing Address - Fax:845-440-6345
Practice Address - Street 1:62 HOOSE BLVD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-440-6345
Practice Address - Fax:845-440-6345
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY552899-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse